Dorothea Orem's Self-Care Theory

INTRODUCTION Dorothea Orem (1914-2007) One of foremost nursing theorists. Born 1914 in Baltimore. Earned her diploma at Providence Hospital Washington, DC 1939 BSN Ed., Catholic University of America 1945 MSN Ed., Catholic University of America Involved in nursing practice, nursing service, and nursing education During her professional career, she worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant Received honorary Doctor of Science degree in 1976 Published first formal articulation of her ideas in Nursing: Concepts of Practice in 197, second in 1980, and in 1995. DEVELOPMENT OF THEORY 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice. 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant professor of nursing education at CUA. She continued to develop her concept of nursing and self care during this time. Orem s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001. MAJOR ASSUMPTIONS People should be self-reliant and responsible for their own care and others in their family needing care People are distinct individuals Nursing is a form of action interaction between two or more persons

Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health A person s knowledge of potential health problems is necessary for promoting self-care behaviors Self care and dependent care are behaviors learned within a socio-cultural context DEFINITIONS OF DOMAIN CONCEPTS Nursing is art, a helping service, and a technology Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments Encompasses the patient s perspective of health condition ,the physician s perspective , and the nursing perspective Goal of nursing to render the patient or members of his family capable of meeting the patient s self care needs To maintain a state of health To regain normal or near normal state of health in the event of disease or injury To stabilize ,control ,or minimize the effects of chronic poor health or disability Health health and healthy are terms used to describe living things It is when they are structurally and functionally whole or sound wholeness or integrity. .includes that which makes a person human, operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings Environment environment components are enthronement factors, enthronement elements, conditions, and developed environment Human being has the capacity to reflect, symbolize and use symbols Conceptualized as a total being with universal, developmental needs and capable of continuous self care A unity that can function biologically, symbolically and socially Nursing client A human being who has "health related /health derived limitations that render him incapable of continuous self care or dependent care or limitations that result in ineffective / incomplete care.

A human being is the focus of nursing only when a self care requisites exceeds self care capabilities Nursing problem deficits in universal, developmental, and health derived or health related conditions Nursing process a system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of care Nursing therapeutics deliberate, systematic and purposeful action, OREM S GENERAL THEORY OF NURSING Orem s general theory of nursing in three related parts:Theory of self care Theory of self care deficit Theory of nursing system A. Theory of Self Care This theory Includes: Self care practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being Self care agency is a human ability which is "the ability for engaging in self care" -conditioned by age developmental state, life experience sociocultural orientation health and available resources Therapeutic self care demand "totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions" Self care requisites - action directed towards provision of self care. 3 categories of self care requisites are- Universal self care requisites Developmental self care requisites Health deviation self care requisites 1. Universal self care requisites Associated with life processes and the maintenance of the integrity of human structure and functioning Common to all , ADL

Identifies these requisites as: Maintenance of sufficient intake of air ,water, food Provision of care assoc with elimination process Balance between activity and rest, between solitude and social interaction Prevention of hazards to human life well being and Promotion of human functioning 2. Developmental self care requisites Associated with developmental processes/ derived from a condition . Or associated with an event E.g. adjusting to a new job adjusting to body changes 3. Health deviation self care Required in conditions of illness, injury, or disease .these include:-Seeking and securing appropriate medical assistance Being aware of and attending to the effects and results of pathologic conditions Effectively carrying out medically prescribed measures Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health care Learning to live with effects of pathologic conditions B. Theory of self care deficit Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem identifies 5 methods of helping: Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Teaching another

C. Theory of Nursing Systems Describes how the patient s self care needs will be met by the nurse , the patient, or both Identifies 3 classifications of nursing system to meet the self care requisites of the patient:Wholly compensatory system Partly compensatory system Supportive educative system Design and elements of nursing system define Scope of nursing responsibility in health care situations General and specific roles of nurses and patients Reasons for nurses relationship with patients and The kinds of actions to be performed and the performance patterns and nurses and patients actions in regulating patients self care agency and in meeting their self care demand Orem recognized that specialized technologies are usually developed by members of the health profession A technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavor ,with or without use of materials or instruments Categories of technologies 1. Social or interpersonal Communication adjusted to age, health status Maintaining interpersonal, intra group or inter group relations for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease Giving human assistance adapted to human needs ,action abilities and limitations 2. Regulatory technologies Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health and disease Promoting human growth and development Regulating position and movement in space

OREM S THEORY AND NURSING PROCESS Orem s approach to the nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands. The steps within the approach are considered to be the technical component of the nursing process. Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations. Comparison of Orem s Nursing Process and the Nursing Process Nursing Process
y

Orem s Nursing. Process

y

Assessment

Diagnosis and prescription; determine why nursing is needed. analyze and interpret make judgment regarding care Design of a nursing system and plan for delivery of care Production and management of nursing systems

y y

Step 1-collect data in six areas:y y y y

The person s health status The physician s perspective of the person s health status The person s perspective of his or her health The health goals within the context of life history ,life style, and health status The person s requirements for self care The person s capacity to perform self care

y y y y

Nursing diagnosis Plans with scientific rationale

Step 2
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Nurse designs a system that is wholly or partly compensatory or supportive-educative. The 2 actions are:Bringing out a good organization of the components of patients therapeutic self care demands Selection of combination of ways of helping that will be effective and

y y

efficient in compensating for/ overcoming patient s self care deficits

y y

Implementation evaluation

Step 3
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Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. collecting evidence in evaluating results achieved against results specified in the nursing system design Actions are directed by etiology component of nursing diagnosis evaluation

y y

Application of Orem s theory to Nursing Process Therapeutic self care demand Adequacy of self Nursing care agency diagnosis Methods of helping

Air Inadequate Maintain Adequate effective respiration Inadequate Water No problem Food maintain sufficient intake

Potential for impaired respiratory status P F fluid imbalance Actual nutritional deficit r/t nausea P/F injury

Guiding & directing Teaching Providing physical support

Hazards Inadequate Prevent spouse Inadequate abuse Promotion of normalcy Maintain Inadequate developmental environment Inadequate Support ed normalcy in environment

Personal development

A/d in Guiding & directing environment Shared housing Guiding & directing Actual delay in Guiding & directing Providing psy support normal dev. R/T Providing physical, psy support early parenthood Level of education

Prevent /manage dev threat

Dev deficit r/t loss of reproductive organs P/F contd. alterations in health status P/F UTI Guiding & directing, teaching Guiding & directing, teaching

Maintenance Inadequate of health status Management Inadequate of disease process Adherence to Inadequate med regimen Inadequate Awareness of potential problems

P/F adherence teaching in self teaching catheterization & OPD RT Actual deficit in awareness of advisability of HRT & RT effects Actual threat to Providing psy support self image Guiding & directing Actual self deficit in planning for future needs

Adjust to loss Inadequate of reproductive ability & dev Inadequate healthy view of illness Adjust life style to cope with change

OREM S WORK AND THE CHARACTERISTICS OF A THEORY Orem's theory interrelate concepts in such a way as to create a different way of looking at a particular phenomenon is logical in nature. is relatively simple yet generalizable is basis for hypothesis that can be tested contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them

can be used by the practitioners to guide and improve their practice must be consistent with other validated theories ,laws and principles Theory Testing Orem s theory has been used as the basis for the development of research instruments to assist researchers in using the theory A self care questionnaire was developed and tested by Moore(1995) for the special purpose of measuring the self care practice of children and adolescents The theory has been used as a conceptual framework in assoc. degree programs also in many nursing schools. Strengths Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing education administration ,and nursing research Specifies when nursing is needed Also includes continuing education as part of the professional component of nursing education Her self care approach is contemporary with the concepts of health promotion and health maintenance Expanded her focus of individual self care to include multi person units Limitations In general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole ,thing Health is often viewed as dynamic and ever changing .Orem s visual presentation of the boxed nursing systems implies three static conditions of health Appears that the theory is illness oriented rather with no indication of its use in wellness settings RESEARCH ON OREM'S THEORY 1. Self-care requirements for activity and rest: an Orem nursing focus 2.Nursing diagnoses in patients after heart catheterization--contribution of Orem 3. Self-care--the contribution of nursing sciences to health care

4. Self-care: a foundational science 5. Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science 6. Dorothea E. Orem: thoughts on her theory 7. Orem's theory in practice. Hospice nursing care 8. Solving the Orem mystery: an educational strategy 9. Orem's family evaluation REFERENCES Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc. Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M. Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America. Whelan, E. G. (1984). Analysis and application of Dorothea Orem s Self-care Practuce Model. Retrieved October 31, 2006. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book